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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Tara Weigand' <br />Department <br />Division/Bureau <br />EME UTIM <br />Engineering <br />BPW Date May 8, 2018 Phone Extension 5998 <br />Legal 0 Attorney Name: <br />Controller RI Controller review is required for all Contracts $,5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing 0 <br />H Agreement Amendment <br />H Contract <br />Ll Proposal L-j Addendum <br />F� Professional Services <br />F] Resolution <br />F-1 Bid Opening <br />El Bid Award <br />F1 Req. to Advertise F1 Title, Sheet <br />0� <br />Quote Opening <br />F] Quote Award <br />F-1 <br />Change Order No. <br />❑ C/O & PCA No. <br />F1 PCA <br />❑ Ease/Encroach. <br />Traffic Control: <br />Residential Handicap Parking <br />Other: <br />Company or Vendor Name <br />El Yes E] No El If Yes, Approved by <br />New Vendor Purchasing <br />MBENVBE Contractor -D—MBE E] WBE <br />MBEANBE Contractor Requested E] No E] Yes Name of Company <br />Project Name 738 S Ironwood Drive Residential Handicap Parking <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Required Contractor's Certification Forms Attached (Non- <br />ColIusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc,) <br />Required For Change Orders Only <br />Amount of El increase $ <br />F] Decrease $ <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy Original <br />H EJ Roger Nawrot, Assistant City Engineer <br />M n Ed Gleckler, Manager Bureau of Traffic & Lighting <br />M F] SBPD <br />